Ultrasound-guided injection of platelet rich plasma versus corticosteroid for treatment of rotator cuff tendinopathy: Effect on shoulder pain, disability, range of motion and ultrasonographic findings

Ibrahim, Doaa H.; El-Gazzar, Nagat M.; El‐Saadany, Hanan M.; Elkhouly, Radwa M

doi:10.1016/j.ejr.2018.06.004

Cited by 36 publications

(63 citation statements)

References 28 publications

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“…Our findings were similar to Shams et al [18] where there was an improvement of VAS, but MRI showed a slight nonsignificant improvement in the grades of tendinopathy/tear. Although, Ibrahim et al [19] revealed that there was a significant improvement of pain and bursitis as our results, yet Shoulder Disability Questionnaire, ROM, and tendinitis were improved in contrary to ours. This could be explained by the analgesic effects of corticosteroid which may be mediated by neuropeptides, calcitonin gene-related peptide, and substance P which are found to increase in tendinopathies [24].…”

Section: Discussioncontrasting

confidence: 97%

“…Our findings were contrary to Shams et al [18] who demonstrated a statistically significant improvement in clinical outcomes 12 weeks after PRP injections but no difference after 24 weeks. Also, Ibrahim et al [19] revealed a significant improvement in VAS, shoulder ROM, tear, and effusion but no improvement in tendinitis or bursitis 8 weeks after PRP injections.…”

Section: Discussionmentioning

confidence: 97%

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What is better for rotator cuff tendinopathy: dextrose prolotherapy, platelet-rich plasma, or corticosteroid injections? A randomized controlled study

Sabaah

Nassif

2020

Egypt Rheumatol Rehabil

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Background Rotator cuff tendinopathy (RCT) is a leading cause of shoulder pain and disability. Management is mainly conservative, but the limited ability of tendons to regenerate is the main cause of unsatisfactory results. So, we conducted our study to compare the efficacy of deep prolotherapy (glucose 25%), platelet-rich plasma (PRP), and betamethasone corticosteroid for treatment of RCT to find the most effective one based on clinical, functional, and radiological assessment. Results Regarding visual analog scale (VAS), it was significantly (p < 0.001) improved after injection among group 1 (prolotherapy group) and group 3 (steroid group) patients, while no significant improvement was noted among group 2 (PRP group) (p = 0.212) patients. The Western Ontario Rotator Cuff (WORC) Index significantly improved among the studied groups (p < 0.001, p = 0.049, and p < 0.001, respectively) after injection. Regarding the range of motion (ROM), a significant improvement (p = 0.029) was achieved in group 1 after injection but no significant improvements were noted among group 2 and 3 patients (p = 0.529 and 0.121, respectively). There was a significant improvement among group 1 and 2 patients (p < 0.001 and p = 0.020, respectively) regarding the grade of tendon lesions but no improvement occurred among group 3 patients (p = 0.470). Conclusion Prolotherapy injections improve shoulder ROM, VAS, WORC index, and rotator cuff tendon healing while PRP injections improve WORC index and tendon healing but steroid injection has no effect on healing. Trial registration PACTR202005610509496. Retrospective registration on May 25, 2020, Pan African Clinical Trial Registry.

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Section: Discussioncontrasting

confidence: 97%

Section: Discussionmentioning

confidence: 97%

What is better for rotator cuff tendinopathy: dextrose prolotherapy, platelet-rich plasma, or corticosteroid injections? A randomized controlled study

Sabaah

Nassif

2020

Egypt Rheumatol Rehabil

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“…Seven full-text articles were evaluated for eligibility ( Figure 1). We excluded two studies comparing PRP to corticosteroid [21,22]. Five RCTs were included for the qualitative synthesis as well as the final meta-analysis (Table 1) [10][11][12][13][14].…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Effectiveness of Platelet-Rich Plasma Injection in Rotator Cuff Tendinopathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Lin

Wei

2020

Diagnostics

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Background: To investigate the effectiveness of platelet-rich plasma (PRP) injection among patients with rotator cuff tendinopathy in comparison with sham injection, no injection, or physiotherapy alone. Methods: From the earliest records to November 1, 2018, all published or unpublished randomized controlled trial (RCTs) comparing PRP injection with a control group (sham injection, no injection, or physiotherapy alone) in patients with rotator cuff tendinopathy were included. Eligible trials were included from the search results of electronic databases including PubMed, EMBASE, Scopus, The Cochrane Library, as well as the bibliographies of relevant trials. Five RCTs were enrolled in our meta-analysis. Two authors independently assessed the quality of RCTs with the Cochrane risk of bias tool. We designated pain reduction as the primary outcome and functional improvement as the secondary outcome. Standardized mean difference (SMD) was applied for random-effect meta-analysis. Results: In the short term (3–6 weeks) and medium term (12 weeks), the effectiveness of PRP injection and control group was indistinguishable in terms of both outcomes (pain reduction and functional improvement). Nevertheless, PRP injection led to significant long-term (>24 weeks) pain relief (SMD: 0.42, 95% confidence interval (CI): 0.12–0.72, without heterogeneity). For functional improvement in the long term, PRP injection was not more effective than the control group (SMD: 1.20, 95% CI: −0.20–2.59, with heterogeneity). Conclusions: PRP injection may provide benefit over the control group (sham injection, no injection, or physiotherapy alone) in reducing pain at long-term follow-up for patients with rotator cuff tendinopathy.

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“…PRP treatment characteristics varied widely among the included studies, though all injections were under ultrasound guidance. For example, PRP parameters included the preparation kit used in five trials, 5,33,[38][39][40] the presence of leukocyte in three trials, [33][34][35] platelet concentration in three trials 5,32,34 and activation agents in seven trials. 5,[32][33][34][35][36][37] After injection, seven studies followed standard rehabilitation programs for rotator cuff tendinopathy or partial-thickness tear.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…For example, PRP parameters included the preparation kit used in five trials, 5,33,[38][39][40] the presence of leukocyte in three trials, [33][34][35] platelet concentration in three trials 5,32,34 and activation agents in seven trials. 5,[32][33][34][35][36][37] After injection, seven studies followed standard rehabilitation programs for rotator cuff tendinopathy or partial-thickness tear. 5,32,33,[37][38][39][40] Two RCTs 33,34 avoided medicine and physical therapy for several months after injections.…”

Section: Study Characteristicsmentioning

confidence: 99%

Conservative treatment of partial-thickness rotator cuff tears and tendinopathy with platelet-rich plasma: a systematic review and meta-analysis

Xiang

Deng

Liu

et al. 2020

Preprint

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PurposeTo assess the effect of platelet-rich plasma (PRP) as a conservative therapy on individuals with partial-thickness rotator cuff tears (PTRCs) or tendinopathy in terms of pain, and function.MethodsA systematic review and meta-analysis of randomized controlled trials were conducted. Short-term (6±1 months) and long-term (≥1 year) outcomes were analysed, including the visual analogue scale (VAS), Constant-Murley score (CMS), Shoulder Pain and Disability Index (SPADI), as well as American Shoulder and Elbow Surgeons (ASES) score. The weighted mean difference (MD) with 95% confidence interval (CI) was used.ResultsTen studies were eligible in this review, nine studies with 561 patients were included in this meta-analysis. The meta-analysis showed statistically significant differences in the decrease in short-term VAS (MD=-1.56; 95% CI -2.82 to -0.30), and increase in CMS (MD=16.48; 95% CI 12.57 to 20.40), and SPADI (MD=-18.78 95% CI -36.55 to -1.02). Nonetheless, no long-term effect was observed on pain and function, except CMS (MD=24.30). The results of mean important differences (MIDs) reached the minimal clinically important differences, except ASES. For subgroup analysis, short-term VAS scores were decreased in PRP-treated patients with double centrifugation (MD=-1.99), single injection (MD=-0.71) and post-injection rehabilitation (MD=-1.59).ConclusionPRP-treated patients with PTRCs and rotator cuff tendinopathy demonstrated improvements in pain and function, although the effect may not last for a long time. Overall, our results suggest that PRP may have positive clinical outcomes, but limited data, and study heterogeneity hinder firm conclusions.

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Ultrasound-guided injection of platelet rich plasma versus corticosteroid for treatment of rotator cuff tendinopathy: Effect on shoulder pain, disability, range of motion and ultrasonographic findings

Cited by 36 publications

References 28 publications

What is better for rotator cuff tendinopathy: dextrose prolotherapy, platelet-rich plasma, or corticosteroid injections? A randomized controlled study

What is better for rotator cuff tendinopathy: dextrose prolotherapy, platelet-rich plasma, or corticosteroid injections? A randomized controlled study

Effectiveness of Platelet-Rich Plasma Injection in Rotator Cuff Tendinopathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Conservative treatment of partial-thickness rotator cuff tears and tendinopathy with platelet-rich plasma: a systematic review and meta-analysis

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